According to the American Heart Association about 795,000 people suffer a stroke each year. Of those strokes almost 140,000 are fatal; this makes Stroke the third leading cause of death in the United States behind coronary heart disease and cancer. Hemorrhagic strokes are caused when an artery in the brain ruptures, such as a ruptured aneurysm. One possible treatment for cerebral aneurysm is a porous tubular structure, similar to a stent, called a flow diverter. A flow diverter can be placed across the neck of a cerebral aneurysm to induce the cessation of flow and initiate the formation of an intra-aneurysmal thrombosis. This excludes the aneurysm from the parent artery and returns the flow of blood to normal. The process of flow diversion alone has been shown to take months to fully exclude the aneurysm. It is possible however with an adjuvant therapy called photothrombosis to accelerate this process so that the aneurysm is excluded within minutes. Previous flow diverting devices have been analyzed to determine optimal characteristics, such as braiding angle and wire diameter. From this information a new optimized device was designed and is now in the process of being tested. In order to evaluate the effect of the device, a model must be created. One such model is the rabbit elastase induced aneurysm, which was characterized so that elastomer models could be created for in vitro studies. Particle Image Velocimetry (PIV) is a method of analysis that utilizes very small glass spheres (between 8 mu m and 12 mu m in diameter) to determine the velocity vectors of fluid flow in an in vitro model. These velocities can be used to calculate hydrodynamic circulation and kinetic energy inside an elastomer model of the elastase induced aneurysm. By comparing these values inside the aneurysm with values for previously developed diverters and a control without a diverter, it can be shown that despite changes in the braiding angle and individual wire thickness that the behavior of the devices is not significantly different (P > 0.05). Flow diversion is also being used in concert with photothrombosis. A flow diverter is used to exclude the neck remnant from the parent vessel and to provide a scaffold for the remodeling of the neck. This combination of techniques allows for very fast and near complete occlusion of the aneurysm thereby excluding the aneurysm from the parent vessel and eliminating the risk of a rupture.

Neuroblastoma is one of the most aggressive cancers and has a complex form of differentiation. We hypothesized that the advanced cellular differentiation may alter the susceptibility of neuroblastoma to photodynamic therapy (PDT) and have a selective survival advantage. We compared the photocytotoxicity treated by Hematoporphyrin (Hp) for PDT on human neuroblastoma SH-SY5Y cells with retinoic acid (RA)-differentiated SH-SY5Y cells. The undifferentiated neuroblastoma cells were shown to cause elevated photocytotoxic effect by MTT assay and also confirmed by Annexin V-FITC/PI staining. In undifferentiated cells, Hp-PDT increased the generation of intracellular reactive oxygen species (ROS), the loss of mitochondrial membrane potential, characteristic chromatin condensation displaying, PARP cleavage, the downregulated expression of Bcl-2, and the activation of caspase-9, -3 was more significant than that of the differentiated cells. In undifferentiated SH-SY5Y cells, cell cycle arrest at G2/M phase was accompanied by the decrease in cyclin B1 level, and could be reversed by the disruption of intracellular ROS caused by PDT. Furthermore, the ROS scavenger markedly inhibited Hp-PDT induced activation of caspase-3, a sustained phosphorylation of Akt/GSK-3£] and ERK, and cytotoxicity in undifferentiated SH-SY5Y cells, but not in differentiated SH-SY5Y cells. Blockage of p38 and JNK activation can significantly attenuate PDT-induced viability loss in both SH-SY5Y cells, but the less significant activation of p38 and JNK, as well as more significant phosphorylation of Akt and GSK-3£], and a prolonged ERK activation appeared to make differentiated SH-SY5Y cells more resistant to photocytotoxicity. Collectively, these data suggested that differentiated SH-SY5Y cells were more resistant to PDT induced apoptosis than undifferentiated SH-SY5Y cells, and ROS played the most important regulatory role on the susceptibility to Hp-PDT between undifferentiated and differentiated neuroblastoma cells. These results may have important implications for neuroblastoma patients undergoing PDT.

Modeling of light propagation through turbid (highly-scattering) media such as living tissue is important for a number of medical applications including diagnostics and therapeutics. This thesis studies methods of performing such simulations quickly and accurately. It begins with a formal definition of the problem, a review of solution methods, and an overview of the current state of the art in fast simulation methods encompassing both traditional software and more specialized hardware acceleration approaches (GPU, custom logic). It introduces FullMonte, the fastest mesh-based Monte Carlo software model available and highlights its novel optimiza- tions. Additionally, it demonstrates the first fully three-dimensional hardware simulator using Field-Programmable Gate Array (FPGA) custom logic, offering large (40x) power-efficiency and performance (3x) gains. Next, a plan for significant future feature enhancements and performance scale-out is sketched out. Lastly, it proposes applying the simulators developed to a number of problems relevant to current clinical and research practice.

Modeling of light propagation through turbid (highly-scattering) media such as living tissue is important for a number of medical applications including diagnostics and therapeutics. This thesis studies methods of performing such simulations quickly and accurately. It begins with a formal definition of the problem, a review of solution methods, and an overview of the current state of the art in fast simulation methods encompassing both traditional software and more specialized hardware acceleration approaches (GPU, custom logic). It introduces FullMonte, the fastest mesh-based Monte Carlo software model available and highlights its novel optimiza- tions. Additionally, it demonstrates the first fully three-dimensional hardware simulator using Field-Programmable Gate Array (FPGA) custom logic, offering large (40x) power-efficiency and performance (3x) gains. Next, a plan for significant future feature enhancements and performance scale-out is sketched out. Lastly, it proposes applying the simulators developed to a number of problems relevant to current clinical and research practice.

Antimicrobial peptides (AMPs) and photosensitizers (PS) have gained attention as potential alternatives to traditional antibiotics for the treatment of microbial infection due to the decreased likelihood for acquired resistance. However, many AMPs and PS suffer from insufficient activity, specificity, or a combination thereof. AMPs can require high concentrations for effective activity, leading to non-specific side effects and increased costs. PS, on the other hand, are quite active, but are typically hydrophobic and suffer from non-specific binding and damage to host tissues. To solve these problems, we report a novel PS-AMP construct of the soluble PS eosin Y conjugated to the selective AMP (KLAKLAK)_(2). Eosin Y has a high singlet oxygen quantum yield, which is suitable for photodynamic activity, although the solubility of eosin Y results in poor binding and activity toward membranes on its own. On the other hand, the specificity of (KLAKLAK)_(2) is high for an AMP, but could still benefit from enhanced activity at lower concentrations. The killing activity and binding specificity of eosin-(KLAKLAK)_(2) toward both bacteria and mammalian cells was assessed using microbiology, biochemistry, and fluorescence microscopy techniques. Additionally, the mechanism of eosin-(KLAKLAK)_(2) activity was investigated using liposome models to determine factors involved in binding and membrane disruption. Furthermore, novel applications of transmission electron microscopy (TEM) methods were employed to observe the photodynamic effects of eosin-(KLAKLAK)_(2) against bacteria. The PS-AMP conjugate eosin-(KLAKLAK)_(2) displays synergistic activity between PS and AMP in model liposome systems, and is capable of killing several clinically relevant bacteria, including the multi-drug resistant Acinetobacter baumannii AYE strain. Furthermore, bacterial killing is achieved in the presence of red blood cells (RBCs) and other mammalian cell lines without significant toxicity. Liposome models reveal that the lipid composition of bacteria is a potential factor responsible for the observed binding specificity and corresponding activity. Additionally, TEM methods show that eosin-(KLAKLAK)_(2) causes extensive membrane damage to both Gram positive Staph aureus and Gram negative Escherichia coli, indicating a primary cause of cell death. A model is proposed where the activities of the PS and AMP, respectively, facilitate the activity of one another, leading to enhanced membrane disruption, and effective antibacterial activity while maintaining cell selectivity.

The interaction of small molecules with DNA has been extensively studied and has produced a large catalogue of molecules that non-covalently bind to DNA though groove binding, intercalation, electrostatics, or a combination of these binding modes. Anthracene, acridine, and carbocyanine-based chromophores have been examined for their DNA binding properties and photo-reactivities. Their planar aromatic structures make them ideal chromophores that can be used to probe DNA structural interactions and binding patterns. We have studied DNA binding and photocleavgage properties of a bisacridine chromophore joined by a 2,6-bis(aminomethyl)pyridine copper-binding linker (Chapter II), a series of 9-aminomethyl anthracene chromophores (Chapters III and IV), both under conditions of high and low ionic strength, as well as a series of pentamethine linked symmetrical carbocyanine dyes (Chapter V). In Chapter II we present data showing that high ionic strength efficiently increases copper(II)-dependent photocleavage of plasmid DNA by the bisacridine based chromophore (419 nm, pH 7.0). In Chapters III and IV, using an pyridine N-substituted 9-(aminomethyl)anthracene (Chapter III), a bis-9-(aminomethyl)anthracene, and its mono 9-(aminomethyl)anthracene analogue (Chapter IV), pUC19 plasmid DNA was photo-converted to highly diffuse DNA fragments (350 nm, pH 7.0) in the presence of 150 mM NaCl and 260 mM KCl. Spectroscopic analyses suggest that the combination of salts promotes a change in DNA helical structure that initiate a switch in anthracene binding mode from intercalation to an external or groove binding interactions. The alteration in DNA structure and binding mode leads to an increase in the anthracene-sensitized production of DNA damaging reactive oxygen species. Finally, in Chapter V, pUC19 plasmid DNA is converted to its nicked circular and linear forms following irradiation of a series of pentamethine linked symmetrical carbocyanines (red light, pH 7.0). The data suggest that the relative levels of photocleavage arise from the different substituents on the nitrogen alkyl side chain and the pentamethine linker.

Ruthenium complexes show promise as light activated photodynamic therapy (PDT) prodrugs. Strained octahedral complexes were synthesized that produce a cytotoxic species upon light activation. pUC19 DNA damage in vitro experiments were carried out to determine the type of damage observed. In vivo cell experiments were carried out on the non-small lung cancer A549 cell line to determine the phototherapeutic window of the synthesized complexes. One mechanism of drug resistance via elevated levels of glutathione was addressed through in vitro binding studies carried out with UV-Vis spectroscopy and in vivo glutathione titrations in the A549 cell line. Several complexes were shown to be potential PDT agents with light-activated activities greater than cisplatin and 10-100 fold lower dark toxicities.

As Ceratoses Actínicas (CA) são lesões hiperceratóticas, displásicas de pele. Estão comumente localizadas em áreas expostas ao sol como couro cabeludo, face e antebraços. Acredita-se que a radiação ultravioleta (RUV) cumulativa seja o maior fator etiológico, considerando-se, também, a imunossupressão e infecção pelo papilomavírus humano(HPV) fatores contribuintes importantes. Existe o potencial de uma CA se transformar em Carcinoma Espinocelular (CEC) e, dessa forma, indica-se tratamento para as referidas lesões. Terapias tradicionais como crioterapia, curetagem e eletrocoagulação, medicações tópicas como 5-fluorouracil (5-FU) são ainda habituais. Porém novas opções como terapia fotodinâmica, diclofenaco e imiquimod 5% creme apresentam boa eficácia e perfil menor de efeitos colaterais, embora possam representar custo maior. A Terapia Fotodinâmica (TFD) envolve o uso de um agente fotossensibilizante, oxigênio e luz de comprimento de onda específico para causar morte celular. O fotossensibilizante geralmente utilizado é o ALA (ácido aminodeltalevulínico) ou seu éster metilaminolevulinato (MAL). No tecido lesionado, esses são convertidos em porfirinas fotoativas (PFAs) por enzimas da via biossintética do heme. A ativação é realizada por meio de luzes de comprimentos de onda que variam de 405 nm a 635 nm. Células displásicas ou neoplásicas produzem maior quantidade de porfirinas que os queratinócitos normais, sendo destruídas durante a aplicação da luz. O imiquimod 5% creme é um imunomodulador que estimula a resposta imune inata através da indução, síntese e liberação de citocinas. Isso resulta em efeitos antitumorais e antivirais indiretos. Seu uso tópico é eficaz e liberado para o tratamento de CA, Carcinoma Basocelular (CBC) superficial, Doença de Bowen (DB) e verrugas vulgares. Este trabalho tem como objetivo comparar duas recentes opções de tratamento para CA, a Terapia Fotodinâmica com metilaminolevulinato e o imiquimod 5% creme, por não existirem, na literatura atual, estudos comparativos dessas duas opções de tratamento. Foram selecionadas 12 pacientes com CAs que foram submetidas primeiramente à 1 sessão de TFD com MAL num lado da face e, 1 mês após, iniciaram o tratamento com imiquimod 5% creme aplicado no lado contralateral, duas vezes na semana, durante 16 semanas. A randomização foi realizada para determinar a hemiface para cada tratamento. Na primeira semana após a realização da TFD e mensalmente durante o tratamento com imiquimod, as pacientes foram avaliadas em relação aos efeitos colaterais dos tratamentos. Seis meses após entrarem no estudo, ambos os tratamentos foram analisados por um investigador cego para sua eficácia, tolerabilidade e seu resultado cosmético. Previamente ao tratamento as pacientes apresentaram um total de 245 lesões de CAs, sendo 120 lesões no lado submetido à TFD e 125 no lado tratado com imiquimod. Após o tratamento o número total de lesões diminuiu para 34 no lado tratado com TFD e para 30 no lado tratado com imiquimod, respectivamente. Não foram observadas diferenças estatisticamente significativas na eficácia de ambos os tratamentos e na frequência de efeitos colaterais. Entretanto, os pacientes, significativamente preferiram o tratamento com a terapia fotodinâmica, talvez pela rapidez do método, comparado com a aplicação tópica do creme de imiquimod a 5%. / Background: Actinic keratosis (AK) represents an initial process that may lead to in situ or invasive squamous cell carcinoma. The importance of its early diagnosis and treatment is well-established. There are several effective options available for the treatment of actinic keratosis, including topical imiquimod 5% cream and photodynamic therapy (PDT). Objetive: To compare the efficacy and patient preference between topical MAL-PDT and imiquimod 5% cream for the treatment of AK. Methods: Twelve patients, with a total of 245 lesions, underwent treatment with MAL-PDT and imiquimod 5% cream. Randomization was performed to determine the hemiface (right or left) for each therapy. First, patients were submitted to MAL-PDT. After one month, they started to use imiquimod on the opposite side of the face, twice a week, for 16 weeks. Six months after entering the study, both treatments were analyzed by a blinded investigator for their effectiveness, tolerability and cosmetic result. Results: Both treatments showed a good therapeutic response. 72% of the lesions treated with MAL-PDT were completely cleared, and 76% of those treated with imiquimod. The mean size of the residual lesions after the treatments was similar. Ten patients (83%) preferred MAL-PDT rather than imiquimod. (p: 0.03). Conclusions: Both MAL-PDT and imiquimod are effective in clearing AKs. Our results showed similar efficacy and good cosmetic outcomes with both treatments. However, a significant percentage of the subjects preferred MAL – PDT.

The purpose of this review is to compile preclinical and clinical results on phthalocyanines (Pcs) as photosensitizers (PS) for Photodynamic Therapy (PDT) and contrast agents for fluorescence imaging. Indeed, Pcs are excellent candidates in these fields due to their strong absorbance in the NIR region and high chemical and photo-stability. In particular, this is mostly relevant for their in vivo activation in deeper tissular regions. However, most Pcs present two major limitations, i.e., a strong tendency to aggregate and a low water-solubility. In order to overcome these issues, both chemical tuning and pharmaceutical formulation combined with tumor targeting strategies were applied. These aspects will be developed in this review for the most extensively studied Pcs during the last 25 years, i.e., aluminium-, zinc- and silicon-based Pcs.

As Ceratoses Actínicas (CA) são lesões hiperceratóticas, displásicas de pele. Estão comumente localizadas em áreas expostas ao sol como couro cabeludo, face e antebraços. Acredita-se que a radiação ultravioleta (RUV) cumulativa seja o maior fator etiológico, considerando-se, também, a imunossupressão e infecção pelo papilomavírus humano(HPV) fatores contribuintes importantes. Existe o potencial de uma CA se transformar em Carcinoma Espinocelular (CEC) e, dessa forma, indica-se tratamento para as referidas lesões. Terapias tradicionais como crioterapia, curetagem e eletrocoagulação, medicações tópicas como 5-fluorouracil (5-FU) são ainda habituais. Porém novas opções como terapia fotodinâmica, diclofenaco e imiquimod 5% creme apresentam boa eficácia e perfil menor de efeitos colaterais, embora possam representar custo maior. A Terapia Fotodinâmica (TFD) envolve o uso de um agente fotossensibilizante, oxigênio e luz de comprimento de onda específico para causar morte celular. O fotossensibilizante geralmente utilizado é o ALA (ácido aminodeltalevulínico) ou seu éster metilaminolevulinato (MAL). No tecido lesionado, esses são convertidos em porfirinas fotoativas (PFAs) por enzimas da via biossintética do heme. A ativação é realizada por meio de luzes de comprimentos de onda que variam de 405 nm a 635 nm. Células displásicas ou neoplásicas produzem maior quantidade de porfirinas que os queratinócitos normais, sendo destruídas durante a aplicação da luz. O imiquimod 5% creme é um imunomodulador que estimula a resposta imune inata através da indução, síntese e liberação de citocinas. Isso resulta em efeitos antitumorais e antivirais indiretos. Seu uso tópico é eficaz e liberado para o tratamento de CA, Carcinoma Basocelular (CBC) superficial, Doença de Bowen (DB) e verrugas vulgares. Este trabalho tem como objetivo comparar duas recentes opções de tratamento para CA, a Terapia Fotodinâmica com metilaminolevulinato e o imiquimod 5% creme, por não existirem, na literatura atual, estudos comparativos dessas duas opções de tratamento. Foram selecionadas 12 pacientes com CAs que foram submetidas primeiramente à 1 sessão de TFD com MAL num lado da face e, 1 mês após, iniciaram o tratamento com imiquimod 5% creme aplicado no lado contralateral, duas vezes na semana, durante 16 semanas. A randomização foi realizada para determinar a hemiface para cada tratamento. Na primeira semana após a realização da TFD e mensalmente durante o tratamento com imiquimod, as pacientes foram avaliadas em relação aos efeitos colaterais dos tratamentos. Seis meses após entrarem no estudo, ambos os tratamentos foram analisados por um investigador cego para sua eficácia, tolerabilidade e seu resultado cosmético. Previamente ao tratamento as pacientes apresentaram um total de 245 lesões de CAs, sendo 120 lesões no lado submetido à TFD e 125 no lado tratado com imiquimod. Após o tratamento o número total de lesões diminuiu para 34 no lado tratado com TFD e para 30 no lado tratado com imiquimod, respectivamente. Não foram observadas diferenças estatisticamente significativas na eficácia de ambos os tratamentos e na frequência de efeitos colaterais. Entretanto, os pacientes, significativamente preferiram o tratamento com a terapia fotodinâmica, talvez pela rapidez do método, comparado com a aplicação tópica do creme de imiquimod a 5%. / Background: Actinic keratosis (AK) represents an initial process that may lead to in situ or invasive squamous cell carcinoma. The importance of its early diagnosis and treatment is well-established. There are several effective options available for the treatment of actinic keratosis, including topical imiquimod 5% cream and photodynamic therapy (PDT). Objetive: To compare the efficacy and patient preference between topical MAL-PDT and imiquimod 5% cream for the treatment of AK. Methods: Twelve patients, with a total of 245 lesions, underwent treatment with MAL-PDT and imiquimod 5% cream. Randomization was performed to determine the hemiface (right or left) for each therapy. First, patients were submitted to MAL-PDT. After one month, they started to use imiquimod on the opposite side of the face, twice a week, for 16 weeks. Six months after entering the study, both treatments were analyzed by a blinded investigator for their effectiveness, tolerability and cosmetic result. Results: Both treatments showed a good therapeutic response. 72% of the lesions treated with MAL-PDT were completely cleared, and 76% of those treated with imiquimod. The mean size of the residual lesions after the treatments was similar. Ten patients (83%) preferred MAL-PDT rather than imiquimod. (p: 0.03). Conclusions: Both MAL-PDT and imiquimod are effective in clearing AKs. Our results showed similar efficacy and good cosmetic outcomes with both treatments. However, a significant percentage of the subjects preferred MAL – PDT.